PET imaging of glucose and fatty acid metabolism for NAFLD patients
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Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
Received Nov 8, 2018; accepted Nov 9, 2018 doi:10.1007/s12350-018-01532-8
See related article, https://doi.org/10.10 07/s12350-018-1446-x. The paper presented in this issue of the Journal by Tang and colleagues illuminate the deficiency in our knowledge of the reciprocal metabolic relationship between liver and heart in health and disease.1 The results presented in this paper used a large number of previously acquired 18F-FDG PET studies to investigate the association between non-alcoholic fatty liver disease (NAFLD) (Figure 1A) and myocardial glucose uptake. Previous work published by Lee and colleagues in Metabolism,2 had found a significant correlation between NAFLD and vascular inflammation using 18FFDG PET to measure maximum target-to-background uptake in the carotid arteries; however, the present study is the first to elicit through imaging the correlation between NAFLD and potential cardiac metabolic abnormalities. Patients with NAFLD have a high risk of related cardiovascular disease (CVD).3 It has been pointed out that the leading cause of death in NAFLD patients is CVD rather than liver-associated complications,4 of which only 5% of NAFLD patients die from liver-related diseases.5 18F-FGD PET is an important indicator of cardiac glucose metabolism and its alteration in the presence of disease; however, to systematically understand the relation between NAFLD and the risk of cardiovascular disease, other probes, in addition to 18FDG, should be used to study the complex and dynamic pathways of energy substrate metabolism in the heart in health and disease and their relationship to the metabolic pathways of other body organs.
Reprint requests: Grant T. Gullberg, PhD, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2018 American Society of Nuclear Cardiology.
The aim of the paper by Tang and colleagues was to investigate the association between NAFLD and myocardial glucose uptake to see if alterations in 18FFDG uptake could be an indicator of cardiac dysfunction in NAFLD individuals. They retrospectively assessed 18 F-FDG PET imaging data of a total of 201 subjects with NAFLD and 542 without NAFLD who were imaged over the years from December 1, 2011 to November 30, 2017. The liver (Figure 1B) in addition to adipose tissue is a major source of lipoproteins (Figure 1C), which are a major substrate for cardiac ATP production. NAFLD is a disease with an extensive amount of fat in the liver. The diagnosis of fatty liver disease was confirmed by CT where disease was indicated if liver attenuation was at least 1 Hounsfield Unit (HU) less than the spleen and the attenuation ratio of liver to spleen was less than 1.0. It was found that myocardial 18F-FDG uptake was significantly lower in individuals with NAFLD compared with those without fatty liver. The authors also demonstrated that in NAFLD patients the glucose upta
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